159例复治肺结核患者耐药特征及影响因素分析

doi:10.19983/j.issn.2096-8493.20210063

摘要/Abstract

摘要：

目的分析复治肺结核患者耐药特征及相关因素,并评估其预测价值。方法以2019年1月至2020年12月新疆医科大学第八附属医院收治的159例复治肺结核患者为研究对象,通过药物敏感性试验将患者分为耐药组(71例)和敏感组(88例)。收集研究对象的人口学资料、临床特点、胸部CT检查结果和实验室检查指标。通过单因素和二项分类logistic多因素回归模型进行分析,鉴定复治肺结核耐药的独立相关因素,并通过受试者工作特征(receiver operating characteristics,ROC)曲线评估其预测价值。结果研究对象的总耐药率为44.7%(71/159)。单因素分析显示,耐药组的病程[(0.82±0.27)年]长于敏感组[(0.29±0.13)年],空洞型肺结核比例(71.8%,51/71)高于敏感组(54.5%,48/88),空洞数[4(2,4)个]多于敏感组[2(1,4)个],肺结核胸部CT评分[(12.61±2.84)分]高于敏感组[(11.22±2.79)分],C反应蛋白(C-reactive protein,CRP)水平[52.60(24.67,80.30)mg/L]高于敏感组[34.04(17.43,58.37)mg/L],白细胞计数[8.90(7.42,11.18)×10⁹/L]高于敏感组[7.76(5.71,10.75)×10⁹/L],差异均有统计学意义(t=15.181,P<0.001;χ²=4.997,P=0.025;Z=2.703,P=0.007;t=3.098,P=0.002;Z=2.604,P=0.009;Z=-2.165,P=0.030)。通过二项分类logistic回归模型调整混杂因素(病程、空洞型肺结核、空洞数、肺结核胸部CT评分、白细胞计数、年龄、既往服药不规律和血小板计数)后,CRP水平与肺结核患者耐药独立相关,其OR值为1.019(95%CI:1.006~1.032,P=0.011)。CRP预测复治肺结核耐药的曲线下面积为0.631,预测的最佳截断值为49.01mg/L,敏感度为57.6%,特异度为69.3%。结论 CRP水平与复治肺结核患者的耐药相关,可能具有预测复治肺结核耐药的潜力。

关键词: 结核,抗多种药物性, C反应蛋白质, 因素分析, 统计学

Abstract:

Objective To analyze independent factors associated with drug resistance in re-treated pulmonary tuberculosis (PTB) patients and evaluate their predictive values. Methods Between January 2019 and December 2020, a total of 159 re-treated PTB patients were divided into drug resistant group (71 cases) and sensitive group (88 cases) according to drug susceptibility test. Demographic data, clinical characteristics, chest computed tomography (CT) characteristics and laboratory test results were collected. Multivariate analysis was performed using binomial logistic regression model to identify independent risk factors associated with drug resistance of re-treated PTB, and their predictive values were evaluated with receiver operating characteristics (ROC) curves. Results The total drug resistance rate was 44.7% (71/159). According to univariate analysis results, average duration of disease in the drug resistant group was longer than that in the sensitive group (0.82±0.27 vs 0.29±0.13, t=15.181, P<0.001), proportion of cavitary PTB in the drug-resistant group was greater than that in the sensitive group (71.8% (51/71) vs 54.5% (48/88), χ²=4.997, P=0.025), average cavity count of the drug resistant group was greater than that of the sensitive group (4 (2, 4) vs 2 (1, 4), Z=2.703, P=0.007), average chest CT score for tuberculosis of the drug resistant group was greater than that of the sensitive group (12.61±2.84 vs 11.22±2.79, t=3.098, P=0.002), average C-reactive protein (CRP) level of the drug-resistant group was higher than that of the sensitive group (52.60 (24.67, 80.30) mg/L vs 34.04 (17.43, 58.37) mg/L, Z=2.604, P=0.009), and average white blood cell count of the drug resistant group was higher than that of the sensitive group (8.90 (7.42, 11.18)×10 ⁹/L vs 7.76 (5.71, 10.75)×10 ⁹/L, Z=-2.165, P=0.030). Binary logistic regression analysis showed that CRP was independently associated with drug resistance in re-treated PTB patients after adjusting for duration of disease, proportion of cavitary PTB, cavity count, chest CT score for PTB, white blood cells, age, previous medication irregularity and counts of blood platelets, and its odds ratio (OR) was 1.019 (95% confidence interval (CI): 1.006-1.032, P=0.011). The area under curve (AUC) of CRP in predicting drug-resistance was 0.631 (standard error: 0.048, P=0.009), and the best cutoff was 49.01mg/L with the sensitivity of 57.6% and specificity of 69.3%. Conclusion CRP was independently associated with drug-resistance in re-treated PTB patients, which had the potential for predicting drug-resistance of re-treated PTB.

Key words: Tuberculosis,multidrug-resistant, C-reactive protein, Factor analysis, statistical

李媛媛, 苏东栋, 阿尔泰. 159例复治肺结核患者耐药特征及影响因素分析[J]. 结核与肺部疾病杂志, 2021, 2(4): 347-351. doi: 10.19983/j.issn.2096-8493.20210063

LI Yuan-yuan, SU Dong-dong, Aertai . Analysis of drug resistance characteristics and influencing factors in 159 patients with re-treated pulmonary tuberculosis[J]. Journal of Tuberculosis and Lung Disease, 2021, 2(4): 347-351. doi: 10.19983/j.issn.2096-8493.20210063

图/表 3

表1

复治肺结核患者耐药影响因素的单因素分析

因素	合计(159例)	耐药组(71例)	敏感组(88例)	统计检验值	P值
年龄[岁,M(Q₁,Q₃)]	50(32,64)	47(33,57)	57(31,68)	Z=-1.799	0.072
性别[例,构成比(%)]				χ²=0.198	0.657
男性	100(62.9)	46(64.8)	54(61.4)
女性	59(37.1)	25(35.2)	34(38.6)
体质量指数( $x -$ ±s)	19.14±1.67	19.06±1.63	19.20±1.70	t=-0.528	0.603
临床特点
病程(年, $x -$ ±s)	0.53±0.19	0.82±0.27	0.29±0.13	t=15.181	<0.001
既往服药不规律[例,百分率(%)]	90(56.6)	35(49.3)	55(62.5)	χ²=2.789	0.095
既往治疗中断[例,百分率(%)]	99(62.3)	42(59.2)	57(64.8)	χ²=0.528	0.468
胸部CT检查结果
空洞型肺结核[例,百分率(%)]	99(62.3)	51(71.8)	48(54.5)	χ²=4.997	0.025
病灶累及肺野数(个, $x -$ ±s)	3.19±1.04	3.34±0.94	3.07±1.10	t=1.638	0.103
空洞数[个,M(Q₁,Q₃)]	3(1,4)	4(2,4)	2(1,4)	Z=2.703	0.007
肺结核胸部CT评分(分, $x -$ ±s)	11.84±2.89	12.61±2.84	11.22±2.79	t=3.098	0.002
实验室检查
结核感染T细胞斑点试验阳性[例,百分率(%)]	124(78.0)	52(73.2)	72(81.8)	χ²=1.685	0.194
C反应蛋白[mg/L,M(Q₁,Q₃)]	40.44 (22.00,69.58)	52.60 (24.67,80.30)	34.04 (17.43,58.37)	Z=2.604	0.009
白细胞计数[×10⁹/L,M(Q₁,Q₃)]	8.49 (6.34,10.83)	8.90 (7.42,11.18)	7.76 (5.71,10.75)	Z=-2.165	0.030
红细胞计数[×10¹²/L,M(Q₁,Q₃)]	4.67 (4.29,5.06)	4.70 (4.31,5.13)	4.65 (4.24,5.05)	Z=-1.210	0.226
中性粒细胞百分比[M(Q₁,Q₃)]	0.707 (0.658,0.778)	0.717 (0.662,0.785)	0.703 (0.649,0.771)	Z=0.943	0.346
淋巴细胞百分比[M(Q₁,Q₃)]	0.159 (0.114,0.218)	0.157 (0.104,0.201)	0.169 (0.122,0.222)	Z=-1.452	0.147
血小板计数(×10⁹/L, $x -$ ±s)	326.62±134.72	349.96±127.53	307.66±138.14	t=1.955	0.052
血红细胞沉降率[mm/1h,M(Q₁,Q₃)]	34.00 (11.24,73.74)	35.50 (12.96,91.71)	32.00 (10.04,49.54)	Z=-1.091	0.275

表1

表2

图1

参考文献 14

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因素	β值	$s_{\bar{x}}$值	Wald χ²值	OR值	95%CI值	P值
年龄	-0.013	0.011	1.348	0.991	0.972~1.010	0.245
病程	0.897	0.581	2.394	2.448	0.788~7.063	0.119
既往服药不规律	-0.432	0.354	1.465	0.647	0.320~1.305	0.227
空洞数	0.091	0.129	0.501	1.094	0.847~1.412	0.480
肺结核胸部CT评分	0.130	0.068	3.509	1.139	0.995~1.306	0.060
空洞型肺结核	0.397	0.385	1.059	1.486	0.671~3.152	0.303
白细胞计数	0.051	0.047	1.016	1.052	0.956~1.158	0.313
C反应蛋白	0.017	0.006	6.579	1.019	1.006~1.032	0.011
血小板计数	0.014	0.009	2.660	1.003	0.996~1.057	0.107

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